Presentation (CTI)

OBJECTIVES: Distributional cost-effectiveness analysis (DCEA) is an analytical framework that allows incorporation of health equity considerations into decision-making. One key input is the distribution of quality-adjusted life expectancy (QALE) across subpopulations. NICE now recommends that DCEAs are conducted for the appropriate equity-relevant subgroup, which for some diseases may be ethnicity. However, in England, QALE estimates by subgroup are currently only available by Index of Multiple Deprivation. This project aims to estimate QALEs by ethnic groups in England to bridge this data gap.
METHODS: We utilised survey data from the Understanding Society database, which is representative of the UK population. We mapped SF-12 to EQ-5D (health-related quality of life measures) for each individual, and used a power transformed linear regression to predict EQ-5D by age and sex, stratified by ethnic group. The optimal power transformation for the regression was determined by a Box-Cox test. We adapted the health state life expectancy estimates template published by the Office for National Statistics to estimate QALE from predicted EQ-5D in each ethnic group and aggregate mortality rates by ethnic group from the Office for National Statistics.
RESULTS: We included survey data on 37,247 people in Wave 7 of the Understanding Society database, which was administered in 2017. A cubic transformation was identified as the optimal power transformation and applied to the linear regression models for each ethnic group. For females, QALE ranged from 63.9 to 74.6 years, for Pakistani and Black African groups, respectively. For males, QALE ranged from 65.9 to 73.9 years, for Bangladeshi and Asian Other groups, respectively.
CONCLUSIONS: These estimates form an alternative indicator of general health by ethnicity, enabling policymakers and researchers to explore health inequalities between different ethnic groups, for example through DCEA, and design tailored public health strategies in response.